Tuesday, April 28, 2009

Residency, husband, baby, nervous breakdown

Old MD Girl recently posted her thoughts on "The Good Life", specifically the musings about it she had heard from a male lecturer. It got me thinking a lot about my experiences so far and what I am facing down when it comes to being a mudphud, married to another mudphud, looking down the barrel of us both being interns and then residents, with a baby on the way and hopes for at least one more in the future.

Like Old MD Girl, I have also been privy to the musings of many a physician or practicing mudphud when it comes to "lifestyle", "goals", "balancing career and family", etc. The striking thing is how differently this is talked about by males vs females.

I do hate to generalize and certainly hate to generalize based on gender--Lord knows I resent it when anyone else does--but I would be lying if I said there wasn't a persistent difference in my experience. So far, without fail, when a man is talking all about how "you CAN have it all", how he has a thriving practice, two grants, and three great kids, he says it all has to do with balance and good decisions and careful planning. I always ask these men: "What does your wife do?" And so far, without fail, they look slightly abashed as they answer, "she stays at home with the kids." Aha. So she's the one running the parts of your life that aren't lab or patients; she's the one that makes sure that when you are at home you get Quality Time with the Family, because she's already done the laundry and the cooking and the shopping and the cleaning and the paying the bills and... well, you get my point.

When women mudphuds or physician-scientists talk about Life Balance, they almost always say you can't really have it all, that something has to give. They talk about hiring help; nannies, cooks, maids, whatever you need to get through. They talk about having to cut back hours sometimes, and finding lots of good after-school programs; about working part time if you have to, and having a very supportive spouse (interestingly, they always bring this up without me having to ask. So far, none of the men have).

There was one exception to this. We heard from a couple who were both physician scientists and had a young child. I'm sure they are perfectly lovely and accomplished people but please believe me of understatement when I say that after hearing their presentation on "balancing" professional and private life, my husband and I wanted to shoot ourselves. Their system went something like this: one would go in to to work around 4am while the other kept the baby until the nanny arrived; then they would both work all day; then the one who went in at 4am would come home around 6 or 7pm and relieve the nanny, while the other would stay at work until around midnight. The one who stayed at home would work from there, writing grants. Sometimes, they said maybe once a week, they would both be home and have dinner together--although this meant one would have to go back to work until 1 or 2am.

Horrible, horrible, horrible, we thought. There must be another way. I don't know about you, readers, but I can't live like that. As I said when I was interviewing for residency and was repeatedly asked why I couldn't expand my geographical area and just live away from my husband for three years: I married him for a reason. I like having him around, and honestly being apart for three years is not an option I am willing to consider. Sorry; life is too short not to be with the ones you love.

Likewise, I can't imagine never seeing my children. I have no delusions that I will not see my daughter as much as I'd like this coming year; however, I can manage because it is a temporary situation. The couple described above intended to keep up such a schedule for at least three years until their fellowships were completed (and hinted it would be many more before their labs were established enough they could give up such a schedule).

I'm sorry, but since when did becoming a doc mirror entering the priesthood? Is it reasonable to expect us to give up any chance at having a life outside of work? Although we both love our chosen fields, my husband and I picked ophthalmology and dermatology partially because we knew those areas gave us the best shot at being able to be fully functional mudphuds--patients and research--without guaranteeing that we would suck at one or the other (or both), and without having years of never seeing each other or our children. Had one or both of us chosen medicine, followed by a fellowship, it's hard to image a way to escape the misery of the docs described above.

I feel there has to be a better way to do things. I worry that by asking so much sacrifice, the most talented people are being driven away from medicine and research, and particularly those fields where they are most needed (primary care, etc.). And the sacrifices seem to only get bigger as time goes on--more debt upon graduation, more hours spent on billing and insurance, more days on the phone with some random dude who has a bachelor's in rhetoric and communications and is trying to tell you how to treat your patient, more years working such long hours that you don't have anything to give at the end of the day to research, much less your family.

We are going to have to face the fact that we would have more, happier, better doctors if we didn't abuse them so. I read that Obama is struggling to find the best way to address the current and growingly alarming doctor shortage. How about allowing them to have a decent quality of life? More debt forgiveness for those who go into primary care; more flexible schedules and hours (which would often mean hiring more docs); more autonomy from the HMOs in how they treat their patients.

Well, I've gotten off topic, but I'm sure you get the gist. I wonder--I hope--my hubby and I are doing the right thing. Most days, I feel pretty confident that our kids will be fine in daycare. We'll have time for them and for each other, and hopefully won't suck at patient care or research. I'm hoping that we CAN "have it all". I'm pretty sure I will need a maid, though, since I'm unlucky enough not to have a stay-at-home spouse running the rest of my life. To those of you who do, I salute you. Just be sure to thank him or her the next time you're bragging about successful you are.


Michelle said...

Great post! You are 100% right on all of this and it's an issue that needs to be discussed more. I'd like to comfort you and tell you it's not that bad and you'll find a great way to handle it all, but that would be a lie. It is at least at tough as you say. It's so much more tough than I imagined.

It's not just doctors -- academic science is the same way. My PI has two young kids so he comes into work very early in the morning, works until 5 PM, goes home for dinner, then comes back until all hours of the night (plus weekends). And I get a lot of pressure for not following the same crazy schedule.

Most of the women grad students I know (and many of the men) plan to avoid academia because they don't see how to balance the work demands with family life - or any life. You made an excellent point: how can you expect to retain the good people if you demand so much sacrifice for it?

Oh, and just to add my own gripe - we need affordable, available daycare options, too. After waiting over a year I still haven't gotten into the daycare 'available' at my school. And if I did get in, it would cost my entire stipend. I found another daycare, luckily, but it took many stressed weeks of searching and still costs almost my entire stipend.

Anonymous said...

What is pediatric dermatology? What do you treat as a pediatric dermatologist? How does one become a pediatric dermatologist? Dr. VonB, do you need to do both a pediatric and derm residency to become a pediatric dermatologist? That's 7 more years of residency combined!

Dr.VonB said...

Thanks Michelle--and I hear you about child care. I too will be paying my entire stipend for care next year. Ugh! And that's not even counting how hard it is to find child care which can cover overnights and weekends in the event that both spouses have call at the same time.

Anon--peds derm is a 1 year fellowship after dermatology residency. So, that would be one year of prelim/internship, three years of derm and 1 year of peds derm fellowship. Plus remember that although there is a LOT of hard work in terms of learning, reading and studying, the hours required in the clinic/hospital during derm residency just can't compare to something like medicine or peds. Peds derm people can see kids or adults since they would be board certified in both general and peds derm. So you would treat anything. Common stuff is eczema, psoriasis, hemangiomas, etc etc...

OneDayMD said...

Absolutely wonderful post. Thanks so much for sharing your thoughts on this. To be honest, the physician lifestyle scares the crap out of me. I'm lucky enough to have a spouse who isn't in the field of medicine and IS interested in staying at home with any kids we might someday have. I just don't think I could follow my dreams otherwise, the way things are set up now. Hopefully this will change in our lifetimes! Again, thanks for sharing, and I'm rooting for you and your family.

Old MD Girl said...

Two words: Au Pair.

One of the residents gave me the rundown this week:

Daycare = $1200/month (normal business hours only, never after 6)
Babysitter (under the table) = $2000/month (above the table multiply by 1.3)
Au Pair = nominal fee + a room in your house + your sanity and the risk that she might run off

Something to think about.

Dragonfly said...

Hope Dr VonB Jnr is doing well and makes a timely appearance.

Bea said...

I stumbled upon your blog from Old MD Girl's blog and I'm really struck by this post.

My husband is a PGY-1 surgery resident and I'm pregnant with our first child. As you know, residents make very little, so I'm the primary breadwinner in our family. Since my husband works crazy hours, I'm also mostly responsible for keeping our house in order. (I'm not talking perfect-- I'm saying basic stuff like having food in the fridge at some point...) Somehow once our baby is born, I've got to juggle child care responsibility too. It's not that my husband doesn't want to help, it's that he cannot possibly help as much as I need him to when he works over 80 hours a week.

So when people ask how doctors "make it all work" and the answer is that their significant other stays at home, I'm frankly terrified. And when I hear stories like the one you described with 2 doctors juggling ridiculous schedules to take care of their kids, I'm also terrified.

I guess this all goes to say that I really related to your post. Like you said, there has got to be a better way. I just hope we figure out what that "way" is... stat.

DK said...

Well stated, doc. I think everyone has to find their own balance, whatever that is (and I agree, dinner once a week in the middle of the night don't sound much like it! But if it works for them...). It's just me and the pup, and I still haven't quite balanced things out yet. It's tough, and there's DEFINITELY a double standard. But, look at what a weird world we're starting in, where 80 hours seems like a reasonable work week... ::sigh::

Anonymous said...

Really good sharing this.